CRPS & All Patients – pills no help for this severe pain

08/18/2016 — Nancy Sajben MD

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Yes, people with nerve pain, CRPS pain, any pain, and often those without pain have this. It can lurk for decades before pain is obvious. But find the right spot and you’ve got it. Doctors and patients fail to understand one of the worst disabling causes of severe pain. Pills, drugs fail to help, but doctors reflexively respond with pills because they often have no training in this. The slightest movement, a sudden flicker of being jarred and pain explodes up to a 9. Pain may catch you by surprise, you yelp, you can’t help it, and you stop instantly. It’s unbearable, the slightest jolt, the wrong angle, a split second. Some reach for a handful of pills, and cut back activity until they are completely unable to walk or move without fear. For others, no jolt or yelp, it just appears and silently gets worse without your knowing, until it manifests decades later and now you cannot function. You forget the incident that set it off.

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CASE

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Healthy 19 year old with pain on standing, walking, wanted a motorized wheelchair on first visit

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This young student had suddenly dropped out of UC Berkeley before the end of the quarter due to severe pain, difficulty walking. The only patient in 41 years of medicine who asked for a motorized wheelchair, was only 19, had no medical illness, no neurological deficit, no inflammatory markers, no injury, but unbearable pain on standing and walking.

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After four months of physical therapy, he was pain free and regained full function, out in the park running with his dog and his friends. Nineteen years old and able to live a normal life. It hurts like crazy. Physical therapy had to get out all the “snags” in muscle and fascia that prevented normal function and caused excruciating pain. There is no magic.

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CASE

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A grandmother with pain in both feet had not been able to stand for six long years. She loved cooking for family and grand kids, but was unable to stand to do anything. She could not walk. In less than two weeks of physical therapy, she was walking 1 to 2 miles a day and loving her life again. Depression vanished. Building her strength to walk more each day.

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Oh, need I explain that when you taper off opioid in a case like these, yes, they will have pain just from withdrawing the opioid – the body wants its opioid back and taper creates pain that may stay high for weeks even months, until the body stops klanging for its opioid and the psyche stops catastrophizing to figure out it can live without vegetating by sedating the brain. Each cell in the body goes wild for its opioid and does not want to give up its drug. The autonomic nervous system goes into overdrive, patients leave your practice to find any of hundreds of thousands of doctors for more opioid that perpetuate the desire to lie back and do nothing to trigger any slight jolt. Just narcotize the brain.

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CAUSE

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Stasis. Inactivity. Not moving. Immobilization. Sedentary muscle, just sitting, or in a cast or after knee surgery, bedridden. Stasis. Simply stasis. Muscles and fascia develop “knots” that you are not aware of until suddenly, the wrong jolt, the slightest move, and you freeze, screaming in pain. Prolonged sitting often causes hip flexion contractures. “Knots” can be felt in muscle, tender points are highly localized. P.T. finds them and causes screaming pain to get them out. My own body has it now in several muscles, both thighs. It’s common. They’re quiet until you find them and mash them. It hurts like crazy to treat it, but that’s the only way to get this silent killer that takes lives. Pills do nothing. Blood curdling yelps and bruises appear during P.T. If you don’t do it, it gets worse. They are not always easy to find, not always a “knot” that can be felt, but zingers they are.

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HOW

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What’s in blood besides red cells, white cells, oxygen? Fibrin and collagen. If you cut yourself, fibrin instantly seals the bleed and forms a clot. The body then builds collagen, a major component of connective tissue. What had been soft tissue can turn into a tough fibrous matrix. Nutrients and oxygen cannot get to it. The “knots” must be properly and precisely released by a skilled physical therapist to find them all, to release them all.

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Just this week, a patient with back pain who quit P.T. early, told me she learned to reduce back pain in bed by placing pillows under the knees, two pillows. Perfect! to develop hip flexion contractures that prevent standing erect, thus throwing out the spine and soon a 3rd or 4th back surgery. Undiagnosed, untreated hip flexion contractures are surely one of the major causes leading to preventable spine surgery.

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Doctors don’t know how or perhaps don’t care to diagnose it.

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Pills do NOTHING to relieve it.

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There is no hope until the knots are undone.

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Compliance is crucial. We have a choice. But in 2003, W.H.O reported: 50% of people don’t comply w/ chronic disease management. Insurance denies medications, insurance limits physical therapy, you are left with rapidly increasing disability and a miserable hell that does not respond to pills of any kind, not even massive doses of opioids.

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STASIS – OBESITY

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Obesity leads to increasing stasis. Let’s not dwell on obesity in itself that causes inflammation and increases estrogen production in fat all over the body – that’s one of the reasons obese men develop breasts. Every woman knows estrogen can cause horrific disabling pain. The more fat we pack on is like adding estrogen producing ovaries all over the body. And fat cells remain hungry for 10 years before new ones arise. We take to walkers and wheelchairs instead of the obvious: lose weight, take pounds of fat off joints, muscles and spine, rid the system of excess pain-producing estrogen, and then work out the knots with physical therapy. Thin people get knots in muscle too but obesity and its load of estrogen is a big culprit.

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Motorized wheelchairs: How many obese individuals are willing to lose weight, even when it means regaining life and use of body? You don’t have to pay money to eat less. Exercise helps but it is not the only way to lose weight, and people may eat more after exercise.

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Seize the day. Failure is not a healthy option but I’ve chosen favorite foods too often. Eat well, nothing between meals, limit protein to 4 oz of fish/chicken/meat or 8 oz dairy/legumes, one piece of fruit in AM with protein, add loads of veggies – 5 cups per day, the low glycemic veggies, one tablespoon oil/butter with each meal. Never skip meals. Plan ahead, carry your own food if you work away from home. Most of all, avoid anything that is high glycemic. Stomach will feel very full, but very eager at the time of next meal. You will find your mood is stabilized. Your joints will not bother you as much or not at all. You will have more energy and less depression.